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Phase 2a Questions > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Angina - Exercise/stress treadmill ECG results

A

ST segment depression - late stage ischaemia

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2
Q

Acute pericarditis - Pain

A
  1. Sharp and pleuritic
  2. Worse on lying flat and better with leaning forward
  3. Left ant chest or epigastrum
  4. Radiates to arm (trapezius ridge - share innervation with phrenic N)
  5. If acute - can be on inspiration
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3
Q

Mitral regurgitation - Ausculation

A
  1. Soft S1 (mitral and tricuspid valve closure)
  2. Pansystolic murmur - from apex to axilla - Intensity =/ severity
  3. Prominent 3rd extra heart sound (S3) in congestive HF/ LA overload
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4
Q

Hypertension - Pharmacological treatment

A

Goal = 140/90
ACD pathway
A - ACE inhibitor (Ramipril/Enalapril) / ARB (Candesartan/Losartan)
C - CCB (Nifedipine/Amlodipine) - 1st line if Black/over 55
D - Diuretics - Thiazide (Bendroflumethazide) or loop (Furosemide)

B blocker - B1 selective (Bisoprolol/Metoprolol) if young/intolerant

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5
Q

Action of Heparin

A

Thrombin and factor Xa inhibitor

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6
Q

Infective Endocarditis - clinical manifestation

A

FROMJANE
F - fever
R - Roth’s spots (retinal haemorrhages w white clear centres on fundoscopy)
O- Osler’s nodes (tender nodules in digits)
M - Murmur of heart
J - Janeway lesion (haemorrhages and nodules in fingers)
A - Anaemia
N - Nail splinter haemorrhage
E - Embolic skin lesions (black spots)

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7
Q

Blood pressure definition

A

Cardiac output x Total Peripheral Resistance

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8
Q

Heart failure - Blood Tests

A

Brain natriuretic peptide (BNP)

  • secreted by vesicles
  • Response to increased myocardial wall stress
  • Correlate w heart failure severity
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9
Q

ACE inhibitor- Bradykinin breakdown

A
  1. Dry chronic cough
  2. Rash
  3. Anaphylactoid reaction
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10
Q

Angina - Scoring

A
  1. Central, tight chest pain w radiation to arms / jaw / neck
  2. Precipitated by exertion
  3. Relieved by rest / GTN spray
    1/3 = non-anginal
    2/3 = atypical
    3/3 = typical
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11
Q

QRISK

A
  1. Age
  2. Gender (male)
  3. Angina/MI in 1st degree relative
  4. Smoking
  5. Hypertension
  6. Hyperlipidaemia
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12
Q

ACE inhibitor + SE

A

Ramipril

Dry chronic cough

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13
Q

MI - ECG

A 
Few mins
1. Hyperacute T waves
2. ST elevation
Few hours
1. T wave inversion
2. R wave voltage decrease
3. Pathological Q waves
Few days
1. ST normal
Few weeks/mth
1. T wave normal
2. Q wave remains
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14
Q

Heart failure - Symptoms

A

Cardinal S

  1. SOB
  2. Fatigue
  3. Ankle swelling
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15
Q

Heart failure - CXR

A 
ABCDE
A- Alveolar oedema
B - Kerley B lines
C - Cardiomegaly
D - Dilated upper lobe vessels of lungs
E - Effusions (pleural)
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16
Q

Tetralogy of Fallot - features

A
  1. Large, maligned ventral septal defect (VSD)
  2. Overriding aorta
  3. RV outflow obstruction (due to pulmonary stenosis)
  4. RV hypertrophy
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17
Q

Pericarditis - ECG

A
  1. Diagnostic
  2. Widespread concave upwards (saddle shaped) ST elevation
  3. Diffuse ST segment elevation in all leads (STEMI - limited to infarcted A)
  4. PR depression
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18
Q

Atrial Fibrillation - ECG

A
  1. No P waves

2. Irregular + rapid QRS complex

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19
Q

Aortic dissection - Clinical presentation

A
  1. Sudden onset of severe + central tearing chest pain - radiate to back and down arms (maximal at onset - unlike MI)
  2. Hypertension
  3. Acute lower limb ischaemia
  4. Neurological S - paraplegia (loss of blood supply to spinal cord)
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20
Q

Chronic limb ischaemia - stages

A
  1. Asymptomatic
  2. Intermittent claudication (cramp on exercise)
  3. Rest pain/nocturnal pain
  4. Necrosis/gangrene
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21
Q

Hypertension - secondary causes

A
  1. Renal disease
  2. Endocrine - Cushing’s, Conn’s
  3. Coarctation of aorta
  4. Drugs –> corticosteroids
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22
Q

Shock - Definition

A

Acute circulatory failure w inadequate/inappropriate distributed tissue perfusion
Hypoxia +/or inability of cells to utilise O2

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23
Q

Shock - Types

A
  1. Cardiogenic
  2. Septic
  3. Anaphylactic
  4. Hypovolaemic
  5. Neurogenic
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24
Q

Aneurysm - complications

A
  1. Rupture
  2. Thrombosis
  3. Embolism
  4. P on other structures
25
Mitral Stenosis - Heart Sounds
1. Diastolic murmur (blood flows over valve) - Low pitched diastolic rumble at apex - Lying on L side in held expiration - Severe = longer 2. Loud opening S1 snap - At apex when leaflets still mobile - then softens and disappears - Abrupt halt in leaflet motion as leaflet tips fuse - Severe = closer to S2
26
Aortic stenosis - Heart sounds
1. Soft/absent S2 2. Prominent S4 - LV hypertrophy 3. Ejection systolic murmur - crescendo decrescendo 4. Loudness =/ severity
27
Action of CCB
1. Block L type Ca channels 2. Dihydroopyridines (felodipine / amlodipine) - Peripheral arterial vasodilators 3. Verapamil - Negative chonotrope (HR) and negative inotrope (Force of contraction) 4. Diltiazem (both)
28
NSAID action
1. Inhibit cyclooxygenase (COX) - breaks down arachidonic acid to prostaglandin H2 - less thromboxane A2
29
Warfarin
1. Inhibits vit K - prevent clotting
30
Ventricular tachycardia - Treatment
1. B blockers - bisoprolol /atenolol (B1) 2. Sustained (>30s) IV amiodarone Emergency electrical cardioversion
31
Furosemide action
Block Na/K/2Cl transporter
32
ACE inhibitor action
Reduce circulating levels of aldosterone | Pril
33
Digoxin effect
1. Bradycardia 2. Increased ectopic activity (extra hearbeats) 3. Positive inotrope (increase force of contraction) by increased intracellular Ca 4. Slow AV conduction
34
Chronic Heart Failure - Pharmacology
1. ACE inhibitor (ramipril) /ARB 2. B blocker (bisoprolol) 2. Diuretics - Loop (ferosemide) - Bendroflumethiazide - Aldosterone antagonist (spirolactone) 3. Digoxin 4. Inotropes
35
B blocker SE
1. Bronchospasm 2. Heart failure 3. Hypotension 4. Bradyarrhythmias
36
Nitrates - SE
1. Headache 2. GTN spray syncope 3. Tolerance
37
CCB - SE
1. -ve chonotrope - Bradycardia - AV block - Postural hypotension 2. Peripheral vasodilation - Flushing - Headache - Oedema - Palpitations 3. -ve inotrope - Worse cardiac failure 4. Verapamil = constipation
38
Alpha 1 adrenoreceptor blocker
Doxazosin
39
B blocker action
1. Reduce O2 demand - Slow hr - Reduce force of contraction 2. Improve O2 distribution - Slow hr
40
Glyceryl trinitrate action
1. Venodilation 2. Reduce venous return to R heart 3. Reduce preload 4. Reduce work of heart 5. Reduce O2 demand
41
SAN
Dominant pacemaker Intrinsic rate of 60-100bpm Fastest depolarising tissue
42
ECG paper
1. Horizontal - 1 small box = 0.04s - 1 big box = 0.2s 2. Vertical - 1 large = 0.5mV
43
CO
CO (L/min) = SV (L) x HR (BPM)
44
Heart sounds
S1 - Mitral/tricuspid valve closure S2 - Aortic and pulmonary V closure S3 - Early diastole during rapid ventricular filling - children, preg, MR, HF S4 - Gallop in late diastole - blood forced into stiff hypertrophic ventricle - LV hypertrophy
45
Cardiac failure - Definition
Inability of heart to deliver blood + O2 at a rate that is commensurate w requirement of metabolising tissue of body
46
Infective endocarditis - causative organisms
1. Staph aureus 2. Pseudomonas aeruginosa 3. Strep viridans (dental problem)
47
Acute pericarditis - Definition
Acute inflammation of pericardium - w/wout effusion
48
Hypertension - values
1. Normotensive <140/90 2. Stage 1 - >140/90 - ABPM/HBPM >135/85 3. Stage 2 - >160/100 - 150/95 4. Severe - S>180 +/or D>110 - Immediate Tx
49
Cardiac arrhythmias - complications
1. Sudden death 2. Syncope 3. HF 4. Chest pain 5. Dizziness 6. Palpitations 7. Asymptomatic
50
RBBB - ECG
1. MaRRoW - QRS like M in V1 - QRS like W in V5+6
51
LBBB - ECG
1. WiLLiaM - QRS like W in V1-2 - QRS like M in V4-6
52
Aneurysm - Definition
Permanent dilation of A to twice normal diameter
53
Acute Lower Limb ischaemia - symptoms
``` 6P's 1. Pain 2. Pallor 3. Perishing cold 4. Pulseless 5. Paralysis 6. Paraesthesia More Ps = more severe ```
54
Shock - recognise
1. Cold, sweaty, pale, vasoconstricted skin 2. Weak/rapid pulse 3. Pulse P reduced - Mean arterial P maintained 4. Reduced urine output 5. Coma
55
Haemorrhagic Shock Classification
Class I vs Class II vs III - 15% blood loss vs 15-30 vs 30-40 - Pulse < 100bpm vs >100bpm vs >120 - BP normal in I and II vs decreased - RR 14-20 vs 20-30 vs decreased - Urine output >30ml/hr vs 20-30 ml/hr vs 5-15 - Slightly vs mildly anxious vs confused
56
Peripheral Vascular disease - Classification
``` Fontaine I = asynical symptoms IIa = mild claudication IIb = mod-severe claudication III = ischaemic rest pain IV = ulceration / gangrene ```
57
Cardiac Failure - Classifications
``` New York Heart Association Class I : No limitation Class II : Slight limitation Class III : Marked limitation Glass IV: Inability to carry out physical activity without discomfort ```
58
CHADSVASC score
Chance of stroke in atrial fibrillation
59
Hypertension - Diagnosis
1. Serum creatinine 2. eGFR 3. Glucose 4. ECG --> LV hypertrophy 5. Fundoscopy - retinal haemorrhage / papilloedema

Phase 2a Questions (14 decks)

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